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   2018| November  | Volume 148 | Issue 5  
    Online since January 21, 2019

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Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions
Krishna Pillay Madhavan Nair, Little Flower Augustine
November 2018, 148(5):522-530
DOI:10.4103/ijmr.IJMR_1762_18  PMID:30666979
Nutrient requirements and recommended dietary allowances (RDAs) are set and revised periodically by the Indian Council of Medical Research. These are meant to guide the population and provide policy directions regarding nutrient requirements corresponding to a healthy population. This review article provides an overview of the current recommendations (RDA, 2010) and the challenges faced by the committee to contextualize RDA to the Indian scenario which has a background of double burden of malnutrition, diverse dietary habits but predominantly home-based cereal-pulse vegetarian diet with low bioavailability of several nutrients and lower consumption of packaged fortified foods. The need for country-specific requirements and harmonization of methodologies related to nutrient requirements and RDA are also discussed. The recommendations fixed for iron have been provided in detail as an example. The measures to carry forward RDA revisions to ensure its sustainability have been emphasized.
  10,026 1,238 1
Body composition techniques
Rebecca Kuriyan
November 2018, 148(5):648-658
DOI:10.4103/ijmr.IJMR_1777_18  PMID:30666990
Body composition is known to be associated with several diseases, such as cardiovascular disease, diabetes, cancers, osteoporosis and osteoarthritis. Body composition measurements are useful in assessing the effectiveness of nutritional interventions and monitoring the changes associated with growth and disease conditions. Changes in body composition occur when there is a mismatch between nutrient intake and requirement. Altered body composition is observed in conditions such as wasting and stunting when the nutritional intake may be inadequate. Overnutrition on the other hand leads to obesity. Many techniques are available for body composition assessment, which range from simple indirect measures to more sophisticated direct volumetric measurements. Some of the methods that are used today include anthropometry, tracer dilution, densitometry, dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis. The methods vary in their precision and accuracy. Imaging techniques such as nuclear magnetic resonance imaging and computed tomography have become powerful tools due to their ability of visualizing and quantifying tissues, organs, or constituents such as muscle and adipose tissue. However, these methods are still considered to be research tools due to their cost and complexity of use. This review was aimed to describe the commonly used methods for body composition analysis and provide a brief introduction on the latest techniques available.
  6,175 1,216 6
National Iodine Deficiency Disorders Control Programme: Current status & future strategy
Kapil Yadav, Chandrakant S Pandav
November 2018, 148(5):503-510
DOI:10.4103/ijmr.IJMR_1717_18  PMID:30666977
Iodine deficiency disorders (IDDs) constitute a significant public health problem globally. In India, the entire population is prone to IDDs due to deficiency of iodine in the soil of the sub-continent and thus both animal and plant source food grown on the iodine-deficient soil. IDDs encompass the spectrum of disability and disease and include goitre, cretinism, hypothyroidism, abortion, stillbirth, brain damage, learning disabilities, mental retardation, psychomotor defects, hearing and speech impairment. Iodine deficiency is known to be the single largest cause of preventable brain damage. IDDs with their causal association with brain development, cognition, and learning disabilities impair the human resource development and progress of the country. The children born in iodine-deficient regions on an average have 13.5 intelligence quotient (IQ) points lesser than children born in iodine-sufficient regions. IDD control programme in India is a public health success story, with 92 per cent of the population consuming iodized salt. The partnership between government agencies, academic institutions, salt industry, development agencies and civil society has been key to achieve this success story. The sustainable elimination of iodine deficiency in India is within reach, what is required is accelerated and coordinated effort by all key stakeholder at national and State level.
  6,715 647 3
Prevalence of hypovitaminosis D in India & way forward
Preeti Kamboj, Supriya Dwivedi, GS Toteja
November 2018, 148(5):548-556
DOI:10.4103/ijmr.IJMR_1807_18  PMID:30666982
Deficiency of vitamin D or hypovitaminosis D is widespread irrespective of age, gender, race and geography and has emerged as an important area of research. Vitamin D deficiency may lead to osteoporosis (osteomalacia in adults and rickets in children) along with calcium deficiency. Its deficiency is linked with low bone mass, weakness of muscles and increased risk of fracture. However, further research is needed to link deficiency of vitamin D with extra-skeletal consequences such as cancer, cardiovascular disease, diabetes, infections and autoimmune disorders. The causes of vitamin D deficiency include length and timing of sun exposure, amount of skin exposed, latitude, season, level of pollution in atmosphere, clothing, skin pigmentation, application of sunscreen, dietary factors and genetic factors. The primary source is sunlight, and the dietary sources include animal products such as fatty fish, food items fortified with vitamin D and supplements. Different cut-offs have been used to define hypovitaminosis D and its severity in different studies. Based on the findings from some Indian studies, a high prevalence of hypovitaminosis D was observed among different age groups. Hypovitaminosis D ranged from 84.9 to 100 per cent among school-going children, 42 to 74 per cent among pregnant women, 44.3 to 66.7 per cent among infants, 70 to 81.1 per cent among lactating mothers and 30 to 91.2 per cent among adults. To tackle the problem of hypovitaminosis D in India, vitamin D fortification in staple foods, supplementation of vitamin D along with calcium, inclusion of local fortified food items in supplementary nutrition programmes launched by the government, cooperation from stakeholders from food industry and creating awareness among physicians and the general population may help in combating the problem to some extent.
  4,437 687 7
Micronutrient status of Indian population
Zaozianlungliu Gonmei, GS Toteja
November 2018, 148(5):511-521
DOI:10.4103/ijmr.IJMR_1768_18  PMID:30666978
Micronutrients play an important role in the proper growth and development of the human body and its deficiency affects the health contributing to low productivity and vicious cycle of malnutrition, underdevelopment as well as poverty. Micronutrient deficiency is a public health problem affecting more than one-fourth of the global population. Several programmes have been launched over the years in India to improve nutrition and health status of the population; however, a large portion of the population is still affected by micronutrient deficiency. Anaemia, the most common form of micronutrient deficiency affects almost 50 to 60 per cent preschool children and women, while vitamin A deficiency and iodine-deficiency disorders (IDD) have improved over the years. This review focuses on the current scenario of micronutrient (anaemia, vitamin A, iodine, vitamin B12, folate, ferritin, zinc, copper and vitamin C) status in the country covering national surveys as well as recent studies carried out.
  4,199 873 2
National control programme against nutritional blindness due to vitamin A deficiency: Current status & future strategy
K Vijayaraghavan
November 2018, 148(5):496-502
DOI:10.4103/ijmr.IJMR_1781_18  PMID:30666976
Vitamin A deficiency (VAD) among 1-5 yr old children is reported to be widely prevalent in Southeast Asia and some parts of Africa. It is the leading cause of preventable blindness in young children in the low-income countries in the world. Children even with milder signs of VAD have higher risk of morbidity and mortality. Inadequate dietary intakes of vitamin A with poor bioavailability associated with frequent infections are the primary contributory factors. Currently available approaches to control VAD are ensuring adequate intakes of vitamin A in daily diets, fortification of foods consumed regularly particularly among the low-income communities and periodic administration of massive dose of vitamin A supported by public health interventions and reinforced by behaviour change communication. Under the National Programme in India, six monthly administration of mega dose of vitamin A to 6-59 month old children has been implemented since 1970, to prevent particularly blindness due to VAD and control hypovitaminosis A. Despite inadequate coverage and poor implementation of the programme, blindness due to VAD in children has almost disappeared, though subclinical VAD is still widely prevalent. Based on the results of meta-analysis of eight trials, which indicated that vitamin A supplementation to children aged 6-59 months reduced child mortality rates by about 23 per cent, the World Health Organization made a strong recommendation that in areas with VAD as a public health problem, vitamin A supplementation should be given to infants and children of 6-59 months of age as a public health intervention to reduce child morbidity and improve child survival. At present, in India, there is a need for change in policy with respect to the national programme to opt for targeted instead of universal distribution. However, NITI (National Institution for Transforming India) Aayog, which formulates policies and provides technical support to the Government of India, recommends strengthening of the National Programme for control of VAD through six monthly vitamin A supplementation along with health interventions. Eventually, the goal is to implement food based and horticulture-based interventions harmonizing with public health measures, food fortification and capacity building of functionaries for elimination of VAD.
  4,365 552 2
Pros & cons of some popular extreme weight-loss diets
Shilpa Joshi, Viswanathan Mohan
November 2018, 148(5):642-647
DOI:10.4103/ijmr.IJMR_1793_18  PMID:30666989
Obesity has now become a huge public health issue not only in the developed world but also in developing countries. In view of the health hazards associated with obesity and more importantly for cosmetic reasons, many people, particularly the youth, have started resorting to 'extreme' weight-loss diets to achieve a rapid reduction in weight. These extreme diets are either very low in carbohydrate or very low in fat. Such extreme diets not only make the diet unbalanced but also have safety issues. Moreover, these are not sustainable in the long run. The weight that is lost is regained within a short period of time when people go off these extreme diets. This explains why the popularity of most extreme diets peaks as well as wanes rapidly. Instead of resorting to such extreme diets, correction of obesity is best achieved with balanced, healthy, nutritious diets which are low in calories, combined with adequate physical activity (exercise). Motivational counselling can also help people to initiate weight loss and sustain this weight loss over longer periods of time.
  3,829 666 1
Nutritional security through crop biofortification in India: Status & future prospects
Devendra Kumar Yadava, Firoz Hossain, Trilochan Mohapatra
November 2018, 148(5):621-631
DOI:10.4103/ijmr.IJMR_1893_18  PMID:30666987
Malnutrition has emerged as one of the most serious health issues worldwide. The consumption of unbalanced diet poor in nutritional quality causes malnutrition which is more prevalent in the underdeveloped and developing countries. Deficiency of proteins, essential amino acids, vitamins and minerals leads to poor health and increased susceptibility to various diseases, which in turn lead to significant loss in Gross Domestic Product and affect the socio-economic structure of the country. Although various avenues such as dietary-diversification, food-fortification and medical-supplementation are available, biofortification of crop varieties is considered as the most sustainable and cost-effective approach where the nutrients reach the target people in natural form. Here, we have discussed the present status on the development of biofortified crop varieties for various nutritional and antinutritional factors. Ongoing programmes of the Indian Council of Agricultural Research on the improvement of nutritional traits in different crops have been presented. Challenges and future prospects of crop biofortification in India have also been discussed. The newly developed biofortified crop varieties besides serving as an important source for livelihood to poor people assume great significance in nutritional security.
  3,684 660 1
Nutrigenomics: Opportunities & challenges for public health nutrition
V Sudhakar Reddy, Ravindranadh Palika, Ayesha Ismail, Raghu Pullakhandam, G Bhanuprakash Reddy
November 2018, 148(5):632-641
DOI:10.4103/ijmr.IJMR_1738_18  PMID:30666988
The hierarchical information flow through DNA-RNA-protein-metabolite collectively referred to as 'molecular fingerprint' defines both health and disease. Environment and food (quality and quantity) are the key factors known to affect the health of an individual. The fundamental concepts are that the transition from a healthy condition to a disease phenotype must occur by concurrent alterations in the genome expression or by differences in protein synthesis, function and metabolites. In other words, the dietary components directly or indirectly modulate the molecular fingerprint and understanding of which is dealt with nutrigenomics. Although the fundamental principles of nutrigenomics remain similar to that of traditional research, a collection of comprehensive targeted/untargeted data sets in the context of nutrition offers the unique advantage of understanding complex metabolic networks to provide a mechanistic understanding of data from epidemiological and intervention studies. In this review the challenges and opportunities of nutrigenomic tools in addressing the nutritional problems of public health importance are discussed. The application of nutrigenomic tools provided numerous leads on biomarkers of nutrient intake, undernutrition, metabolic syndrome and its complications. Importantly, nutrigenomic studies also led to the discovery of the association of multiple genetic polymorphisms in relation to the variability of micronutrient absorption and metabolism, providing a potential opportunity for further research toward setting personalized dietary recommendations for individuals and population subgroups.
  3,463 819 4
Prevention & control of fluorosis & linked disorders: Developments in the 21st Century - Reaching out to patients in the community & hospital settings for recovery
Andezhath Kumaran Susheela, GS Toteja
November 2018, 148(5):539-547
DOI:10.4103/ijmr.IJMR_1775_18  PMID:30666981
The review on fluorosis addresses the genesis of the disease, diagnostic protocols developed, mitigation and recovery through nutritional interventions. It reveals the structural and functional damages caused to skeletal muscle and erythrocytes, leading to clinical manifestations in fluorosis. Hormonal derangements resulting in serious abnormalities in the health of children and adults are discussed. Fluoride toxicity destroys the probiotics in the gut, resulting in vitamin B12depletion, an essential ingredient in haemoglobin (Hb) biosynthesis. The article provides an overview of National Technology Mission on Safe Drinking Water and its contributions to fluorosis control. National Programme for Prevention and Control of Fluorosis is presently in operation in India and its focus cited. Major emphasis has been laid on a variety of disorders surfacing in India due to fluoride toxicity/fluorosis as 'fluorosis-linked disorders', viz. anaemia in pregnancy, schoolchildren, thyroid hormone abnormalities, hypertension, iodine deficiency disorders/goitre, renal failure and calcium+vitamin D-resistant rickets in children. The major action taken by the Indian Council of Medical Research (ICMR), Government of India in establishing a Centre of Excellence for Fluorosis Research in India and its contributions are highlighted.
  3,317 510 1
Are excess carbohydrates the main link to diabetes & its complications in Asians?
Viswanathan Mohan, Ranjit Unnikrishnan, S Shobana, M Malavika, RM Anjana, V Sudha
November 2018, 148(5):531-538
DOI:10.4103/ijmr.IJMR_1698_18  PMID:30666980
Dietary carbohydrates form the major source of energy in Asian diets. The carbohydrate quantity and quality play a vital function in the prevention and management of diabetes. High glycaemic index foods elicit higher glycaemic and insulinaemic responses and promote insulin resistance and type 2 diabetes (T2D) through beta-cell exhaustion. This article reviews the evidence associating dietary carbohydrates to the prevalence and incidence of T2D and metabolic syndrome (MS) in control of diabetes and their role in the complications of diabetes. Cross-sectional and longitudinal studies show that higher carbohydrate diets are linked to higher prevalence and incidence of T2D. However, the association seems to be stronger in Asian-Indians consuming diets high in carbohydrates and more marked on a background of obesity. There is also evidence for high carbohydrate diets and risk for MS and cardiovascular disease (CVD). However, the quality of carbohydrates is also equally important. Complex carbohydrates such as brown rice, whole wheat bread, legumes, pulses and green leafy vegetables are good carbs. Conversely, highly polished rice or refined wheat, sugar, glucose, highly processed foods such as cookies and pastries, fruit juice and sweetened beverages and fried potatoes or French fries are obviously 'bad' carbs. Ultimately, it is all a matter of balance and moderation in diet. For Indians who currently consume about 65-75 per cent of calories from carbohydrates, reducing this to 50-55 per cent and adding enough protein (20-25%) especially from vegetable sources and the rest from fat (20-30%) by including monounsaturated fats (e.g. groundnut or mustard oil, nuts and seeds) along with a plenty of green leafy vegetables, would be the best diet prescription for the prevention and management of non-communicable diseases such as T2D and CVD.
  2,654 484 6
Nature's bountiful gift to humankind: Vegetables & fruits & their role in cardiovascular disease & diabetes
Kamala Krishnaswamy, Rajagopal Gayathri
November 2018, 148(5):569-595
DOI:10.4103/ijmr.IJMR_1780_18  PMID:30666984
Fruits and vegetables (FVs) are recognized as healthy constituents of diet and a sustainable solution to the existing twin burden of micronutrient deficiencies and non-communicable diseases in developing and developed countries. In general, FVs are nutrient dense foods low in energy, containing varying amounts of vitamins and minerals including carotenoids, B vitamins, vitamin C, iron, zinc, potassium, calcium, magnesium and fibre. These are abundantly rich in phytochemicals that function as antioxidants, anti-atherosclerotic and anti-inflammatory agents. This review summarizes some epidemiological, prospective cohort and intervention studies on the health benefits of FVs in relation to cardiovascular disease, obesity and diabetes. The rich varieties of FVs available, their composition, production scenario in India, dietary intake and trends over time, barriers to sufficient intake mainly sociocultural, economic and horticulture environment, policies for promotion and prevention of diseases are considered.
  2,643 403 3
Undernutrition in children & critical windows of opportunity in Indian context
R Hemalatha, KV Radhakrishna, B Naveen Kumar
November 2018, 148(5):612-620
DOI:10.4103/ijmr.IJMR_1963_18  PMID:30666986
It is intriguing to note that majority of the wasting among the under 5 yr in India is present at birth. The National Family Health Survey 4 (NFHS-4) data analysis shows 31.9 per cent wasting at birth, which is decreasing to 17.7 per cent in the under five children; clearly suggesting that any reduction in wasting should come from improvement in foetal growth. In addition, children with both severe wasting and severe stunting, in whom the risk of mortality increases many folds, are <1 per cent in almost all the States; and these are the children in whom special care is required under the community-based management of severe acute malnutrition. This article presents an overview of nutrition status in children, their antecedents, and the critical phases; especially, nutrition status before pregnancy that plays a crucial role in all the nutrition status indicators of children. More attention on the critical phases is crucial to maximize the benefits from national programmes.
  2,301 532 2
National Institute of Nutrition: 100 years of empowering the nation through nutrition
SubbaRao M Gavaravarapu, R Hemalatha
November 2018, 148(5):477-487
DOI:10.4103/ijmr.IJMR_2061_18  PMID:30666974
The National Institute of Nutrition (NIN) has reached a remarkable milestone of completing 100 years of exemplary service to the nation. The long journey that started in a humble one-room laboratory at Coonoor (now in Tamil Nadu) in 1918 to a colossus of the nutrition research in the country today is dotted with several interesting vignettes. The NIN has always been at the forefront of need-based, pragmatic research. Its large-scale community-based interventions have been of great practical value in the nation's fight against malnutrition. The evolution of nutrition as a modern science almost coincides with the growth of the Institute. Being the oldest in the fraternity of institutes under the Indian Council of Medical Research (ICMR), the NIN has grown from strength to strength due to the sheer relevance of its contributions in furthering nutrition science and promoting public health in the country. This article provides a historical overview of the evolution and contributions of ICMR-NIN in the areas of nutrition, food safety, public health and policy.
  2,343 444 -
Protein quality & amino acid requirements in relation to needs in India
Nirupama Shivakumar, Sumedha Minocha, Anura V Kurpad
November 2018, 148(5):557-568
DOI:10.4103/ijmr.IJMR_1688_18  PMID:30666983
The relevance of protein and its constituent amino acids (AAs) in the structure and function of the human body is well known. Accumulating evidence has conferred specific functional and regulatory roles for individual AAs, adding relevance to their requirements across different age groups. The methods for measuring AA requirements have progressed from the classical nitrogen balance to the current stable isotope-based AA balance methods. Requirements of most of the indispensable AA (IAA) have been estimated in healthy Indian population by the best available balance method and has shown to be higher than earlier 1985 WHO/FAO/UNU (World Health Organization/Food and Agriculture Organization/United Nations University) recommendations. In addition, potential changes in the requirement, through adaptation to chronic undernutrition or to infection, have also been evaluated. In 2007, the WHO/FAO/UNU released a recommendation that increased the daily IAA requirement, based on primary evidence from Indian balance studies. This meant that to ensure that the new IAA requirements were met, individual foods or mixed diets needed to be assessed for their protein quality, or their ability to deliver the required amount of IAA. The recent FAO report on protein quality evaluation recommends the use of a new chemical AA score, the digestible IAA score (DIAAS), to replace the earlier protein digestibility corrected AA score. The DIAAS requires the determination of individual AA digestibility at the ileal level. A minimally invasive dual stable isotope tracer-based approach has been developed in India and has been used to determine digestibility of various foods in Indian adults and children. The increase in IAA requirements and subsequent protein quality requirements have implications for national regulatory frameworks, growth and development, and in turn, for economic and agricultural policy.
  2,141 374 1
A review of selected nutrition & health surveys in India
Komal Rathi, Preeti Kamboj, Priyanka Gupta Bansal, GS Toteja
November 2018, 148(5):596-611
DOI:10.4103/ijmr.IJMR_1808_18  PMID:30666985
Assessment of the status of health and nutrition of a population is imperative to design and implement sound public health policies and programmes. The various extensive national health and nutrition surveys provide national-level information on different domains of health. These provide vital information and statistics for the country, and the data generated are used to identify the prevalence and risk factors for the diseases and health challenges faced by a country. This review describes the various national health and nutrition surveys conducted in India and also compares the information generated by each of these surveys. These include the National Family Health Survey, District Level Household Survey, Annual Health Survey, National Nutrition Monitoring Bureau Survey, Rapid Survey on Children and Comprehensive National Nutrition Survey.
  1,858 421 1
Precision diabetes: Where do we stand today?
Viswanathan Mohan, Ranjit Unnikrishnan
November 2018, 148(5):472-475
DOI:10.4103/ijmr.IJMR_1628_18  PMID:30666973
  1,419 404 1
Journey from food toxins to food safety: Transition over a century in service of nation
Vasanthi Siruguri
November 2018, 148(5):488-495
DOI:10.4103/ijmr.IJMR_1692_18  PMID:30666975
Since the first report of lathyrism in 1926, the ICMR-National Institute of Nutrition (NIN) at Hyderabad, India, has made tremendous contributions in the field of food toxins/food safety for the benefit of the people. The present article highlights the Institute's work on various food toxins/foodborne diseases since its inception and discusses the important contributions made in the context of public health protection that formed the basis for several national policies on their prevention and control. The investigations on food toxins, in the initial decades, were limited to the description of lathyrism and its endemicity. Subsequently, the horizon was broadened to include the problem of mycotoxins and mycotoxicosis, which had received global attention and variety of other disease outbreaks investigations leading to total food safety transition in the forthcoming decades. Important contributions in epidemiological investigations, reproduction of the disease in experimental animals, surveillance and monitoring studies, development of methods for detection of food toxins and contaminants, evolving strategies for prevention and control and developing the concept of risk assessment and risk management for addressing food safety issues in the country are discussed.
  1,067 385 -
It's time we turn our attention to quality of food as well
R Hemalatha, GS Toteja, Balram Bhargava
November 2018, 148(5):469-471
DOI:10.4103/ijmr.IJMR_2233_18  PMID:30666972
  943 405 -
Glucose & energy homeostasis: Lessons from animal studies
NV Giridharan
November 2018, 148(5):659-669
DOI:10.4103/ijmr.IJMR_1737_18  PMID:30666991
Glucose in our body is maintained within a narrow range by the humoral control and a 'lipostat' system regulated by leptin from adipose tissues, which keep our accumulated fat stores in check. Any disturbance in this delicately poised homeostasis could be disastrous as it can lead to obesity and its associated metabolic manifestations. Laboratory animals, especially rodents, have contributed to our knowledge in understanding this physiological mechanism through an array of genetic and non-genetic animals developed over the years. Two rat mutant obese models-Wistar inbred at National Institute of Nutrition (WNIN)/Ob-obese rats with normal glucose levels and WNIN/GR-Ob-obese with impaired glucose tolerance were developed in the National Centre for Laboratory Animal Sciences (Now ICMR-National Animal Resource Facility for Biomedical Research) at Hyderabad, India. These animals are unique, as, unlike the earlier models, they show all types of degenerative disorders associated with obesity, within a single system. Thus they show impairment in all the major organs of the body - liver, pancreas, kidney, bones, muscles, gonads, brain, eyes, and are sensitive to diet manipulations, have compromised immunity, often develop tumours and have reduced life span. One may argue that there are limitations to one's interpretations from animal studies to human application, but then one cannot shut one's eyes to the new lessons they have taught us in modifying our life styles.
  958 230 1